Real-Noval Héctor, Fernández-Fernández Jénnifer, Soler-Dorda Guillermo
Servicio de Cirugía General y del Aparato Digestivo, Hospital de Laredo, Laredo, Cantabria.
Servicio de Neurología, Hospital San Agustín, Avilés, Asturias. España.
Cir Cir. 2019;87(4):443-449. doi: 10.24875/CIRU.19000706.
Gangrenous cholecystitis (GC) must be promptly treated for its high morbimortality. The object of our study is to identify clinical, laboratory or ultrasound factors that might us diagnose GC.
A Retrospective cohort study is devised including all patients admitted to Hospital de Laredo (Cantabria, Spain) between 2015 and 2017 with the diagnose of acute cholecystitis and having been operated. Patients were classified in two groups according to pathology: GC and non-GC. We compared their demographics characteristics, comorbidities, laboratory parameters and ultrasound findings.
A total of 115 patients were operated, of whom 32 had CG and 83 CNG. Neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) showed significantly increased levels in GC group (p = 0.042) and CRP (p < 0.0001). To CRP showed an area under the ROC curve of 0.872 (95% confidence interval: 0.797-0.946). Acalculous cholecystitis was significantly associated to GC (24.1 vs. 7%; p < 0.005). In the multivariate analysis only the CPR showed as a predictive factor. A cutting point of CRP at 15.25 mg/dl, that had high sensibility (90.6%) and high negative predictive value (95%).
CRP helped identify patients with CG to indicate early surgical intervention.
坏疽性胆囊炎（GC）因其高病死率必须得到及时治疗。我们研究的目的是确定可能有助于诊断GC的临床、实验室或超声因素。
设计一项回顾性队列研究，纳入2015年至2017年期间入住西班牙坎塔布里亚拉雷多医院且诊断为急性胆囊炎并接受手术的所有患者。根据病理将患者分为两组：GC组和非GC组。我们比较了他们的人口统计学特征、合并症、实验室参数和超声检查结果。
共有115例患者接受了手术，其中32例患有CG，83例患有CNG。GC组中性粒细胞与淋巴细胞比值和C反应蛋白（CRP）水平显著升高（p = 0.042），CRP（p < 0.0001）。CRP的ROC曲线下面积为0.872（95%置信区间：0.797 - 0.946）。无结石性胆囊炎与GC显著相关（24.1%对7%；p < 0.005）。在多变量分析中，只有CPR显示为预测因素。CRP的切点为15.25 mg/dl，具有高敏感性（90.6%）和高阴性预测值（95%）。
CRP有助于识别CG患者以指示早期手术干预。
